American Journal of Drug and Alcohol Abuse最新文献

Background: Canada legalized cannabis for adult (recreational) use in 2018, alongside regulations on the sale, use, and possession of cannabis. To date, there is little evidence on consumer perceptions and support of cannabis regulations.Objectives: This study examined perceptions of nine cannabis regulatory policies, including differences by cannabis consumption and provincial policy.Methods: National survey data were analyzed from Wave 5 of the International Cannabis Policy Study conducted online in 2022 with 16,812 Canadians aged 16+ years, 62% of which were assigned female-at-birth. Weighted logistic regression models examined support for nine policy variables.Results: Support among Canadians was greatest for health warnings on cannabis products (62.6%), legalization for adult use (58.5%), and retail store window-coverings (49.2%), followed by a vaping/extract THC limit (40.1%), retail store density (35.5%), government-only store models (34.6%), the THC limit on edibles (32.3%), and advertising restrictions (31.8%). The 30 g purchasing limit had the least consumer support (10.1%). As consumption increased, opposition generally increased, although support remained high among consumers. Compared to non-consumers, daily consumers were more likely to oppose window-coverings (OR = 1.43, CI95 = 1.16-1.75, p = .001). Where policies differed provincially, few differences in support were observed. No differences in support for THC limits on vaping/extracts were observed between Newfoundland, Nova Scotia, and Quebec versus the rest of Canada, despite stronger vaping/extract regulations (OR = 1.05, CI95 = 0.87-1.28, p = .597).Conclusion: Canadians generally support existing cannabis regulations that were implemented to support public health. The high level of support among consumers suggests that the comprehensive regulations may not undermine transitions to legal retail sources.

Background: Literature regarding opioid use disorder (OUD) is often difficult for nonscientific communities to access. The OUD database on RefBin categorizes scientific findings and may facilitate access to information regarding OUD.Objectives: To evaluate if the RefBin OUD database improves access to information about OUD for policymakers and medical students.Methods: 31 medical students and 13 individual policymakers completed this study. Using a cross-over method, participants answered questions about OUD. Speed, accuracy, confidence, and satisfaction metrics were collected and compared between searches that used RefBin vs other resources chosen by participants.Results: At baseline, medical students reported being comfortable with scientific literature and familiar with OUD. Policymakers reported low comfort levels with scientific literature and variable familiarity with OUD. Within the medical student sample, the odds of answering correctly were 2.43 times higher for RefBin searches than for searches using resources other than RefBin (non-RefBin searches) (p = .005; 95% CI: (1.31, 4.51)). For policymakers, the odds of answering correctly were 3.65 times higher for RefBin vs non-RefBin searches (p = .0496; 95% CI: [1.002, 13.279]). Medical students reported feeling confident in their results 50.7% of the time when using RefBin, compared to 28.3% with non-RefBin searches (p = .006).Conclusion: When compared with searching using non-RefBin sources, searches performed using RefBin resulted in improved accuracy and efficiency for both medical students and policymakers. This demonstrates the potential utility of the RefBin OUD database in improving access to reliable information about OUD.

Background: Cannabis use during pregnancy continues to rise, yet research examining cannabis use in perinatal American Indian women is lacking. Structural injustices have led to health inequities for American Indian people, including higher prevalence of past-month cannabis use and lower prevalence of receiving mental health treatment, compared to other racial and ethnic groups.Objective: To describe perceptions of risks and benefits of perinatal cannabis use in a sample of American Indian perinatal women who report regularly using cannabis while pregnant.Method: A qualitative descriptive study was conducted with 10 American Indian perinatal women who reported using cannabis at least weekly while pregnant or postpartum. Participants were from three states where cannabis use is legal for adults (Washington, Oregon, and California). Themes were generated from implicit and explicit participant responses and principles of Indigenous research frameworks were utilized.Results: Four themes were derived from the data: 1) Perinatal cannabis use as better than other substances, 2) Medicinal use and perceived therapeutic effects of prenatal cannabis, 3) Unsure if cannabis use while breastfeeding impacts the baby, and 4) Minimal responses from healthcare providers perceived as approval.Conclusions: Cannabis was used for health-related issues and was perceived to be a safer option for than use of methamphetamine, heroin, alcohol, and prescription pharmaceuticals. With a focus on other substance use issues within participants' communities, minimal discussion about cannabis use by healthcare providers was perceived as endorsement of use, highlighting the need for additional training for healthcare providers.

Background: Early adolescent ethanol exposure increases the risk of developing an alcohol use disorder. The mechanisms underlying this relationship may involve early ethanol exposure influencing anxiety or altering ethanol sensitivity.Objectives: To examine how adolescent binge drinking impacts sensitivity to ethanol intoxication, withdrawal symptoms, anxiety, compulsive behaviors, and ethanol intake in adulthood.Methods: Thirty-seven male Wistar rats self-administered ethanol during adolescence [postnatal days (PD) 27-45] or were housed under control conditions. In adulthood, the rats received intragastric intubations to simulate heavy alcohol (PDs 61-65, 3 daily doses of 0.0 or 1.5 g/kg) exposure. Intoxication and withdrawal symptoms were assessed (PDs 61-70), along with compulsive behaviors (marble burying test, PD68) and anxiety-related behaviors (light-dark box and elevated plus maze tests, PDs 69-70). Two-bottle choice tests provided measures of ethanol intake (PDs 75-87).Results: Adolescent binge exposure increased ethanol consumption in adulthood (p < .001; η2 = 0.51), with binge-exposed rats drinking 4.5-6.5 g/kg/day vs. 2 g/kg/day in controls. Binge-exposed rats exhibited reduced sensitivity to ethanol intoxication (p < .05; η2 = 0.17). Withdrawal symptoms were significantly greater (p < .005; η2 = 0.36) in rats exposed to alcohol during adulthood compared to controls, regardless of binge ethanol exposure. Anxiety or compulsive behaviors were unaffected by binge ethanol.Conclusions: Adolescent binge drinking led, in male rats, to significant increases in ethanol intake and reduced sensitivity to intoxication in adulthood. These findings suggest that early ethanol exposure results in decreased ethanol sensitivity, potentially increasing the likelihood of ethanol use. Adolescent binge drinking is a key vulnerability factor, and interventions should target this behavior.

Background: Substance use among college students has negative academic and health outcomes. Identifying substances that are more commonly used by students than non-students can reveal specific risks in the college environment.Objectives: To examine associations between college enrollment and prevalence and trends of use of a comprehensive list of substances.Methods: The sample included 2015-2019 participants in the National Survey on Drug Use and Health who were aged 18 to 22 and who were full-time enrolled or not enrolled in college. Prevalence of substance use was calculated for four subgroups: college males (n = 6,707), college females (n = 8,284), non-college males (n = 10,019), and non-college females (n = 9,266). Multivariate logistic regression was used to model the relationships between enrollment and substance use. Temporal trends in substance use prevalence were calculated for each subgroup.Results: College enrollment was associated with prescription stimulant misuse (aOR 1.50, 95% CI: 1.35-1.67), alcohol use (aOR 1.36, 95% CI: 1.27-1.47), and binge drinking (aOR 1.22, 95% CI: 1.15-1.30). From 2015 to 2019, the only substance whose use significantly increased among any subgroup was cannabis. The increase occurred among females only (+4.7% in college females and +5.6% in non-college females; both p < .01).Conclusions: College enrollment is most strongly associated with prescription stimulant misuse, suggesting that colleges should consider explicitly including stimulant misuse prevention in their health promotion strategies. The increasing use of cannabis among females warrants clinicians' attention to routine screening for use and provision of information about the mental health impacts of cannabis.

Background: Hyperkatifeia describes amplified emotional and motivational withdrawal due to addiction-related sensitization of brain-stress-systems. Hyperkatifeia has been proposed as a target for addiction treatment development. However, translation of basic research in this area will require new tools designed to measure hyperkatifeia and related phenomena outside of laboratory settings.Objectives: We define a novel concept, withdrawal interference, and introduce a new tool - the Withdrawal Interference Scale (WIS) - which measures the impact of withdrawal on daily life among individuals with OUD or AUD.Methods: Described are the combined results of three separate cross-sectional studies. The structural validity, convergent validity, construct validity, trans-diagnostic (AUD/OUD) configural, metric, and scalar invariance, internal consistency, and composite reliability of WIS was tested among three independent samples of 1) treatment-seeking adults with OUD (n = 132), 2) treatment-seeking adults with AUD (n = 123), and 3) non-treatment-seeking adults with OUD (n = 140). Males numbered 218 and females were 163.Results: WIS exhibited structural validity (1 factor), convergent validity (average variance extracted .670-.676), construct validity, trans-diagnostic configural (χ2/df = 2.10), metric (Δχ2 = 5.70, p = .681), and scalar invariance (Δχ2 = 12.34, p = .338), internal consistency (α .882-928), and composite reliability (.924-.925).Conclusion: These results suggest WIS is a valid and reliable instrument for measuring withdrawal-related life disruption in AUD and OUD. Further, given our findings of transdiagnostic measurement invariance, WIS scores of individuals with AUD and OUD can be meaningfully compared in future statistical analyses.

Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (r_s (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (r_s (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (r_s (119) = 0.421, p < .001), history of leaving the hospital against medical advice (r_s (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (r_s (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD.

Background: Gabapentinoids are ligands of a brain calcium channel, which are approved for different indications, including epilepsy, neuropathic pain, or generalized anxiety disorder. Among gabapentinoids, pregabalin has been increasingly associated with a risk of pregabalin use disorder (PUD). To date, there is no recommended medical treatment for PUD. However, gabapentin, which has a lower abuse potential, could be used as a substitution therapy to reduce pregabalin withdrawal and craving.Objectives: To report on the experimental use of high dose of gabapentin among those with PUD.Methods: Case series of four patients (3 males and 1 female) with severe PUD (average daily doses ranging from 1,200 to 8,400 mg of pregabalin), in whom high dose of gabapentin was prescribed as a substitution treatment.Results: Upon gabapentin being administered as substitution therapy for pregabalin, all four patients experienced intense craving and distress. Despite receiving high doses of gabapentin, due to the observed levels of craving and distress, all four patients had to be rapidly switched back to pregabalin.Conclusions: Preliminary clinical findings suggest that gabapentin is unlikely to be a suitable, lower-risk alternative treatment for people with PUD. Additional examination of candidate medications, including other gabapentinoids, could be useful to identify an effective treatment for PUD.

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

Background: The emergence of new psychoactive substances (NPSs) poses a serious global health threat. Although various groups of psychostimulants exist, this study specifically investigated two lesser-studied substances, 4,4'-dimethylaminorex (4,4'-DMAR) and escaline.Objective: To assess liability to substance use disorder (SUD), as evidenced via preclinical models, of the two psychostimulants.Methods: 4,4'-DMAR and escaline were evaluated, in mice, for their potential to exhibit rewarding and reinforcing effects, and for causing central dopaminergic activity. The climbing behavior test investigated whether the substances acted as dopaminergic agents and to determine the dose range for further evaluation. The rewarding and reinforcing effects of these substances were evaluated via the conditioned place preference (CPP) and self-administration (SA) tests.Results: The results showed that both test substances significantly increased climbing behavior at 1 mg/kg (p < .01). Mice treated with 0.1 and 1 mg/kg 4,4'-DMAR (p < .05) and with 1 mg/kg escaline (p < .01) exhibited increased duration of time spent in the substance-paired compartment in the CPP test compared to those treated with vehicle. Further, the frequency of infusions from the 5^th to 7^th sessions was significantly increased at 1 mg/kg/infusion of 4,4'-DMAR (p < .001) and at 0.01 and 0.1 mg/kg/infusion of escaline (p < .01) compared to controls.Conclusion: The findings suggest that 4,4'-DMAR and escaline have dopaminergic activity, exert reinforcing and rewarding effects, and may cause SUD. The findings can inform relevant authorities about the need to regulate these two new compounds.